The Journal of Bone and Joint Surgery (American). 2006;88:604-610.
doi:10.2106/JBJS.D.02864
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) After Arthroplasty in the Lower Extremity

Joshua D. Nelson, MD, PharmD1, Joshua A. Urban, MD2, Thomas L. Salsbury, MD3, Jason K. Lowry, MD3 and Kevin L. Garvin, MD4

1 Department of Orthopedic Surgery, University of Kansas Medical Center, Mail Stop 3017, 3901 Rainbow Boulevard, Kansas City, KS 66160-7387. E-mail address: jnelson3{at}kumc.edu
2 Nebraska Orthopaedic Associates, Doctors Building South, Suite 409, 4239 Farnam Street, Omaha, NE 68131
3 Department of Orthopaedic Surgery, Truman Medical Center, 2301 Holmes, Kansas City, MO 64108
4 Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 981080 Nebraska Medical Center, Omaha, NE 68198-1080

Investigation performed at the Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Acute colonic pseudo-obstruction, also known as Ogilvie syndrome, is an uncommon postoperative complication of total hip and total knee arthroplasty that is characterized by massive colonic dilatation and the potential for substantial morbidity and mortality.

Methods: We conducted a retrospective case-control study of 1170 total hip and knee arthroplasties performed by one surgeon from 1995 to 2002, and identified eighteen patients with Ogilvie syndrome. Radiographs and medical records were analyzed for risk factors and treatment effectiveness.

Results: Eleven (1.6%) of 708 patients who had a total hip arthroplasty and seven (1.5%) of 462 patients who had a total knee arthroplasty had Ogilvie syndrome develop postoperatively. Seventeen of these patients had preoperative conditions and/or had received medications identified as risk factors for Ogilvie syndrome. The use of patient-controlled analgesia was associated with an earlier development of symptoms. Colonic decompression was performed in seven patients and was associated with a significantly shorter hospital stay (p = 0.019).

Conclusions: Acute colonic pseudo-obstruction was equally prevalent after total hip and total knee arthroplasties. Most patients who had Ogilvie syndrome had risk factors that could be identified preoperatively. Knowledge of these risk factors can enable the physician to anticipate which patients may have Ogilvie syndrome develop and, therefore, to be vigilant for its development and judicious in the use of patient-controlled analgesia. We also found that decompressive colonoscopy reduced the risk of perforation and decreased the length of hospitalization for the patients in whom Ogilvie syndrome developed.

Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.


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